Bupropion was added to lithium and/or levothyroxine in four female and two male bipolar II patients who had established baselines of at least 2 years of rapid cycling that had not responded to several of the most commonly used anticycling interventions. Although all six patients improved significantly, the response was dramatic in four (three female, one male) and is still sustained after an average of 2 years of continued treatment. Furthermore, unlike what happened in their prior course with more conventional antidepressants, none developed hypomania nor was rapid cycling observed during the course of continued pharmacotherapy. These findings, based on open but systematic clinical observation, suggest that bupropion may have special merit for rapid cycling, predominantly depressed bipolar patients and that, under close clinical vigilance, combining bupropion with appropriate doses of lithium is both efficacious and safe.
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